title: Cross-cultural adaptation of the Health Education Impact Questionnaire: experimental study showed expert committee, not back-translation, added value.
abstract: OBJECTIVE
  To assess the contribution of back-translation and expert committee to the content and psychometric properties of a translated multidimensional questionnaire.
  
  
  METHODS
  Recommendations for questionnaire translation include back-translation and expert committee, but their contribution to measurement properties is unknown. Four English to French translations of the Health Education Impact Questionnaire were generated with and without committee or back-translation. Face validity, acceptability, and structural properties were compared after random assignment to people with rheumatoid arthritis (N = 1,168), chronic renal failure (N = 2,368), and diabetes (N = 538). For face validity, 15 bilingual people compared translations quality with the original. Psychometric properties were examined using confirmatory factor analysis (metric and scalar invariance) and item response theory.
  
  
  RESULTS
  Qualitatively, there were five types of translation errors: style, intensity, frequency/time frame, breadth, and meaning. Bilingual assessors ranked best the translations with committee (P = 0.0026). All translations had good structural properties (root mean square error of approximation <0.05; comparative fit index [CFI], ≥0.899; and Tucker-Lewis index, ≥0.889). Full measurement invariance was observed between translations (ΔCFI ≤ 0.01) with metric invariance between translations and original (lowest ΔCFI = 0.022 between fully constrained models and models with free intercepts). Item characteristic curve analyses revealed no significant differences.
  
  
  CONCLUSIONS
  This is the first experimental evidence that back-translation has moderate impact, whereas expert committee helps to ensure accurate content.
authors.affiliation: INSERM, CIC-EC, CIE6, Service d'Épidémiologie et Évaluation Cliniques, Hôpitaux de Brabois, Allée du Morvan, 54500 Vandoeuvre-lès-Nancy, France; CHU Nancy, Epidémiologie et Evaluation Cliniques, Hôpitaux de Brabois, Allée du Morvan, 54500 Vandoeuvre-lès-Nancy, France; Université de Lorraine, Université Paris Descartes, Apemac, EA 4360, Faculté de Médecine, 9 avenue de la Forêt de Haye, 54505 Vandoeuvre-lès-Nancy, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Epstein
authors.affiliation: Public Health Innovation, Population Health Strategic Research Centre, Deakin University, Burwood Campus, 221 Burwood Highway, Melbourne VIC 3125, Australia.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Osborne
authors.affiliation: Public Health Innovation, Population Health Strategic Research Centre, Deakin University, Burwood Campus, 221 Burwood Highway, Melbourne VIC 3125, Australia.
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Elsworth
authors.affiliation: Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond St. Toronto Ontario M5B 1W 8, Canada; Institute for Work and Health, 481 University Avenue, Suite 800 Toronto, Ontario M5G 2E9, Canada; Institute of Health Policy, Management and Evaluation, Graduate Department of Rehabilitation Sciences, 500 University Av. Toronto, Ontario M5G 1V7 Canada.
authors.forename: Dorcas E
authors.initials: DE
authors.lastname: Beaton
authors.affiliation: INSERM, CIC-EC, CIE6, Service d'Épidémiologie et Évaluation Cliniques, Hôpitaux de Brabois, Allée du Morvan, 54500 Vandoeuvre-lès-Nancy, France; CHU Nancy, Epidémiologie et Evaluation Cliniques, Hôpitaux de Brabois, Allée du Morvan, 54500 Vandoeuvre-lès-Nancy, France; Université de Lorraine, Université Paris Descartes, Apemac, EA 4360, Faculté de Médecine, 9 avenue de la Forêt de Haye, 54505 Vandoeuvre-lès-Nancy, France. Electronic address: francis.guillemin@chu-nancy.fr.
authors.forename: Francis
authors.initials: F
authors.lastname: Guillemin
mesh_terms: D003431:Cross-Cultural Comparison; D005260:Female; D006266:Health Education; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D012107:Research Design; D011795:Surveys and Questionnaires; D014177:Translations
keywords: Back-Translation; Complex measurement scale; Cross-cultural adaptation; Experimental study; Expert committee; heiQ